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Home
About us
Services
- Fire Victim relief service
- Flood Victim Relief Service
Areas
- El Paso, TX
- Horizon, TX
Gallery
Blog
Contact Us

Take a quiz to access help

First Relief Victim Assistance Questionnaire

Please complete this short form so our team can better understand your situation and connect you with the right resources.

All information is confidential and used only to assist you in your road to recovery.

Contact Information

First name

Last name

Email

Preferred method of contact

Phone Text Email

Property address

Mailing address if different

Best time to reach you

Incident Details

Type of incident (Check all that apply):

Fire Flood / Water Damage Smoke Damage Vehicle Impact Crime Scene / Trauma Biohazard / Hoarding Other

Briefly describe what happened

Is the property currently safe to enter?

Yes No

Has the property been secured or boarded up?

Yes No

Has the power and water been shut off?

Yes No

Occupants and Safety

Who lives at the property?

Homeowner Renter / Tenant Family Member

Number of adults?

Number of children?

Was anyone injured in the incident?

Yes No

If yes please describe

Were any animals injured or displaced in the incident?

Yes No

If yes please describe

Do you currently have a safe place to stay?

Yes No

If no, would you like assistance with temporary housing?

Yes No

Insurance & Ownership

Do you have property insurance?

Yes No Unsure

If yes, which company?

Have you filed a claim yet?

Yes No

If yes, claim number (if available)

Are you the property owner?

Yes No

If no, provide landlord or management company name & contact:

Immediate Needs

Please check all that apply so we can connect you with the right help:

Board-Up / Property Security Temporary Power / Fencing Temporary Housing Clothing or Basic Necessities Pet Assistance Policy Review / Insurance Guidance City Compliance / Fire Investigation Funding Resources GoFundMe Assistance (for qualifying cases) Counseling or Emotional Support Coordination for Restoration / Mitigation Services Other

Additional Information

Is there anything else we should know about your situation or special needs?

How did you hear about 1st Relief?

Fire Department Police Department Friend / Family Social Media Other

Acknowledgment

By submitting this form, I understand that 1st Reliefis a nonprofit organization providing consultation, coordination, and resources to assist victims of disaster. I authorize a representative to contact me regarding available assistance and next steps.

Signature *

Date *

Contact Info

Email

jakefromcomplete@gmail.com

Phone

915-999-1066

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